Healthcare Provider Details

I. General information

NPI: 1770395063
Provider Name (Legal Business Name): KISMET BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 14TH ST STE A
MERIDIAN MS
39301-4202
US

IV. Provider business mailing address

PO BOX 3574
MERIDIAN MS
39303-3574
US

V. Phone/Fax

Practice location:
  • Phone: 604-481-4821
  • Fax: 601-640-4013
Mailing address:
  • Phone: 601-481-4821
  • Fax: 601-640-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KATRINA LANDRUM
Title or Position: CEO
Credential: FPMHNP-BC
Phone: 601-481-4821